Prevalence and moderators of depression symptoms among Black individuals in Western Countries: a systematic review and meta-analysis among 1.3 million people in 421 studies

Background Black people living in Western countries face a range of structural challenges and disparities (e.g. difficult socio-economic conditions, historical and intergenerational trauma, police brutality, racism) that adversely affect their mental health. This study assesses depression prevalence among Black individuals in minority contexts, examining sociodemographic factors, study type, evaluation period, publication year, and measures; and differences in depression rates between Black individuals and other racial groups (Asian, Indigenous, Latinx, White). Methods To identify studies, a comprehensive search strategy was developed and executed on September 30, 2022 across six databases (Allied and Complementary Medicine Database, APA PsycInfo, CINAHL. Cochrane CENTRAL, Embase, MEDLINE). The meta-analysis protocol was registered with PROSPERO (CRD42020155634). A random- effects meta-analysis estimated depression prevalence among Black individuals. Meta-regression tested differences by racial background, gender, sample type, evaluation method, age group, and publication year, reporting Odd ratios (ORs) with Confidence intervals (CIs). Findings From 21,215 citations, 421 studies were included with a sample of 1,305,366 Black individuals (411 studies were conducted in North America, 9 in Europe, and one in both Europe and North America). Pooled prevalence was 20.2% (95% CI: 18.7%-21.7%) among Black individuals, 13.4% (95% CI: 10.2-16.9) among Asians, 21.0% (95% CI: 18.7-23.5) among Latinx, and 17.8% (95% CI: 16.3-19.2) among Whites. It was significantly lower among White (OR = 0.98, p = 0.04, 95% CI: 0.95, 1.00) and Asian people (OR = 0.94, p = 0.004, 95% CI: 0.90, 0.98) compared to Black individuals. Pooled prevalence was 26.6% for the past week (95% CI: 24.6%-28.6%), 22.1% (95% CI: 19.2-23.1) for the past two weeks, 21.6% (95% CI: 11.6-33.5) for the past month, 9.1% (95% CI: 7.7%-10.7%) for the past year, and 16.6 (95% CI: 12.9-20.8) for lifetime. Depression prevalence was higher among Black women (24.3%; 95% CI: 21.3-27.4) and in North America (20.3%; 95% CI: 18.8-21.9). Depression prevalence was higher in 2000-2009 (23.5%; 95% CI: 20.9-26.2), decreased in 2010-2019 (17.7%; 95% CI: 15.6-19.9) and increased since 2020 (20.6%; 95% CI: 17.5-23.8). Interpretation As depression constitutes a burden among Black individuals in the West, it is urgent to mobilize public health agencies, research funding agencies and clinicians to develop and implement antiracist and culturally adapted prevention and intervention programs.